Anemia: Folic Acid Supplements

Folate refers to the B vitamin in its natural form found in foods. Folic acid describes the synthetic vitamin found in vitamin supplements or fortified foods like breakfast cereal. It can be challenging to meet your daily folate requirements through diet alone. You must be sure to include in your diet at least two or three folate-rich foods from the table on page 7. A good start to making sure you are meeting your RDA is a daily multivitamin and mineral. When choosing a brand, select a product that has 0.4 to 1.0 milligrams (400-1000 micrograms) of folate. B complex supplements that provide all eight B vitamins in one pill will also give you this amount of folic acid.

If you decide to take a folic acid supplement, make sure to buy one with vitamin B12, since these two nutrients work closely together (that’s why I prefer a high-potency multi or a B complex). The body uses folic acid to activate B12 and vice versa. So a deficiency of one vitamin will eventually lead to a deficiency of the other. Supplementing with folic acid and neglecting to meet your B12 requirements can hide an underlying B12 deficiency. Folic acid supplementation will correct the anemia, and a blood test will find your red blood cells normal, but the nerve symptoms of a B12 deficiency can still progress.

Folic acid is well tolerated. It is generally recommended that you do not exceed the tolerable upper limit of 1000 micrograms per day. However, if you suffer from a malabsorption problem, higher doses can be safely used (be sure to take vitamin B12, too). Doses above 15,000 micrograms are associated with nerve and intestinal damage.

Vitamin B12

Vitamin B12 and folate work very closely together in the body. Without enough B12, your body is unable to use folate, leading eventually to a folate deficiency and megaloblastic anemia (your blood test will show large, immature red blood cells). Alone, vitamin B12 maintains the protective covering of nerve fibers. Your bones also rely on this B vitamin for normal metabolism.

In addition to developing the anemia related to a folate deficiency, a lack of B12 can lead to pernicious anemia. This type of anemia is caused by impaired B12 absorption, not by poor dietary intake. After you consume B12 from your diet, the acid in your stomach helps to release the vitamin from proteins in food. The vitamin then binds to an intrinsic factor that enables B12 to be absorbed into the bloodstream.

A vitamin B12 deficiency can occur for two reasons. Some people produce an insufficient amount of hydrochloric acid in their stomach. This condition, called atrophic gastritis, is common in older adults. Without enough stomach acid, B12 can’t be released from food proteins and it won’t be absorbed into the blood.

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Some people inherit a defective gene for intrinsic factor. They don’t produce this necessary factor that attaches to B12 and transports it into the bloodstream. A B12 deficiency caused by a lack of intrinsic factor leads to pernicious anemia. This anemia is characterized by a deficit of red blood cells, muscle weakness and nerve damage. Most doctors prefer to treat pernicious anemia with injections of vitamin B12, although oral supplements may also be effective. A recent study found that taking a B12 supplement dissolved under the tongue, twice daily, was as effective as shots in restoring B12 levels.2

For the amount of B12 women need on a daily basis, see the RDA table on page

9 in chapter 1. This vitamin is found exclusively in animal foods. If you eat meat, poultry and dairy products on a regular basis you’re probably not at risk for a B12 deficiency. See the B12 in Foods table on page 10 in chapter 1 for some of the best food sources of vitamin B12.

B12 Supplements

If you are a strict vegetarian who eats no animal products and you don’t drink a fortified soy or rice beverage, I strongly recommend a B12 supplement. In fact, anyone over the age of 50 should be getting their B12 from a supplement or fortified foods. That’s because the bodies of up to one-third of older adults produce inadequate amounts of stomach acid and are therefore inefficient at absorbing B12 from food.

If you take certain medications you should consider taking extra B12 in the form of a supplement. If you suffer from reflux or ulcers and take acid blockers (e.g., Tagamet®, Zantac®, Pepcid®) your body may not absorb enough B12 (as well as iron). Metformin®, used to manage type 2 diabetes and polycystic ovary syndrome, can also deplete B12 levels. If you take these medications, your doctor should monitor your blood periodically for signs of anemia.

To get your B12, I recommend a good multivitamin and mineral supplement or a B complex supplement that contains the whole family of B vitamins. If you take a single B12 supplement, take 500 to 1000 micrograms once daily. If you are taking a high-dose B12 supplement to correct a deficiency, don’t take it with a vitamin C pill. Large amounts of vitamin C can destroy B12. Take your vitamin C supplement one hour after you take your B12.

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